MIDTERMS: Topic 6
o COGNITION is the ability to process,
retain, and use information.
o Cognitive abilities include REASONING,
JUDGMENT, ATTENTION,
COMPREHENSION, and MEMORY.
o These cognitive abilities are essential for
many important tasks, including making
decisions, solving problems, interpreting the
environment, and learning new
information.
Are characterized by the disruption of thinking,
memory, processing, and problem solving.
RISK FACTORS
 Physiological changes: neurological,
metabolic, and cardiovascular disease
 Cognitive changes
 Family genetics
 Infections
 Tumors
 Sleep disorders
 Substance Abuse
 Drug intoxication and withdrawals
SIGNS AND SYMPTOMS
1. Irritability: Mood most frequently seen in
organic brain disorder
2. Change in level of consciousness
3. Difficulty thinking with sudden onset
4. State of awareness ranging from
HYPERVIGILANCE to STUPOR or COMA
5. Impairment in cognition and thought
process, particularly short-term memory
6. Anxiety
7. Confabulation - use of imaginary
experiences or made-up information to fill
in gaps of memory loss
DEMENTIA
o Is a syndrome of acquired, persistent
intellectual impairment with
compromised function in multiple
spheres of mental activity such as
memory, language, emotion, personality, and
cognition.
o It may occur with many other medical
illnesses such as pulmonary, hepatic,
cardiopulmonary, and nutritional, as well as
substance induces.
Types of Dementia
1. Dementia of the Alzheimer’s Type -
insidious and progressive, deterioration in
function due to neurotransmitter
deficiency.
2. Vascular Dementia - due to significant
cerebrovascular disease, caused by
multiple infarcts in the cortex
 3. Dementia due to HIV - related to brain
infections with a range of symptoms from
acute delirium to profound
dementia.
4. Dementia due to Head Trauma -
intellectual and memory difficulties due to
post-trauma
5. Dementia due to Parkinson’s Disease
- caused by a loss of nerve cells and a
decrease in dopamine activity
6. Dementia due to Huntington’s Disease
- damage from this disease occurs in the area
of the basal ganglia and cerebral
cortex. A profound state of dementia and
ataxia occurs within 5-10 years of onset.
7. Dementia due to Pick’s Disease -
atrophy in the frontal and temporal lobes of
the brain
8. Dementia due to General Medical
Diseases:
 Endocrine disorders
 Pulmonary disease
 Hepatic or Renal Failure
 medication, such as
anticonvulsants
 Toxin such as lead, mercury,
carbon monoxide, and industrial
solvents
SIGNS AND SYMPTOMS
1. Impairment of abstract thinking,
judgment, and impulsive control
2. Disregard for rules of social conduct
3. Neglect of personal appearance and
hygiene
4. Altered language pattern
5. Personality change
Signs and Symptoms of Progressive Phase
1. Aphasia
2. Irritability and moodiness with sudden
outbursts over trivial issues
3. Inability to care for personal needs;
Incontinence
4. Wandering away from home
5. Impaired remote memory
THERAPEUTIC NURSING MANAGEMENT
1) ENVIRONMENT: The nurse plays a primary
role in providing a safe environment that is
free of excess stimulation. Cognitive
changes often include a period of
confusion and forgetfulness. Maintaining a
structured and consistent environment with
routine patterns helps to reduce the level of
anxiety and confusion of the
client. The nurse must encourage family
members to orient the client.
2) PSYCHOLOGICAL TREATMENT: May focus
more on the family, to offer them
support during this stressful time.
Individual and group therapy are not
helpful with the client. Cognitive
changes decline often means a change in the
family roles.
DELIRIUM
o Is characterized by a disturbance of
consciousness and a change in cognition that
develops rapidly over a short period of time.
It usually begins abruptly
following head trauma or a seizure;
however, the onset may be slower if the
etiology is metabolic. Duration is usually
brief and subsides upon recovery
condition.
 RISK FACTORS
1. Medical conditions: Delirium may be
due to a general medical condition, such
as systemic infection, metabolic
disorder, fluid and electrolyte
imbalance, hepatic or renal disease, etc.
2. Substance induced: Symptoms may be
attributed to side effects of
medications or drugs of abuse.
3. Substance intoxication: Symptoms
may occur following high doses of
cannabis, cocaine, hallucinogens,
alcohol, anxiolytic or narcotics.
4. Substance withdrawal: May occur after
the reduction or termination of a
substance.
5. Delirium is a common post
anesthesia event.
SIGNS AND SYMPTOMS
a) Speech that is rambling, irrelevant,
pressured and incoherent
b) Impaired reasoning and goal-directed
behavior
c) Disorientation to time and place
d) Extreme distractibility
e) Psychomotor activity that fluctuates
between agitation and a vegetative state
f) Interruption of sleep-wake-cycle
g) Emotional instability
THER APEUTIC NURSING MANAGEMENT
1) Restructure the environment to maintain
excessive sensory stimulation
2) Provide orientation cues in the
surrounding area: clocks, calendars,
photographs, memorabilia, seasonal
decorations, and familiar objects
3) Windows are a great way to enhance the
client’s orientation to time. Lightning
may help to decrease the “sundowning
effect” and reduce hallucinations.
4) Ensure safety in the physical
environment
5) Minimize any sensory impairment by
providing eyeglasses or hearing assistive
devices, as needed.
6) Allow clients to care for self as much as
possible
7) Administer antipsychotic or antibiotic
agents as ordered
DISSOCIATIVE FUGUE
o Has a memory loss about many aspects of
the past, often precipitated by a traumatic
event, such as war, conflicts, natural
disaster, or criminal behavior.
o The client has confusion about his/her
identity and may adopt a new one.
o It is not the result of an organic disorder.
o Recovery can be rapid, spontaneous, and
complete.
RISK FACTORS
1. Psychodynamic theory: Behavioral
theory and biological theory offer the
same explanation as dissociative
amnesia.
2. Theory of Family Dynamics:
Unsatisfactory parent/child relationship, with
subsequent internalization of an inner loss has
been associated with dissociative fugue. Also
unfulfilled
separation anxiety, defect in personality
development, and unmet dependency needs
are thought to contribute to this disorder.
 3. Traumatic Event: War, conflicts, criminal
behavior, natural disaster, or any
significant loss.
4. Child abuse may trigger a dissociative
episode.
b. Hypnotherapy must be used to
enhance client memory.
2) Administer anxiolytic agents for
symptoms, however, there is no specific
medication to treat a dissociative fugue.

NURSING INTERVENTIONS
LOCAL AMNESIA
the inability to recall the incidents associated with a
traumatic event for a specific period following the
event.
SELECTIVE AMNESIA
the inability to recall certain incidents associated
with traumatic event for a specific period of time
GENERAL AMNESIA
the inability to recall anything that has
happened to the client during the client’s life,
including personal identity.
1. Supportive care as required until
memory returns
2. Assist the client in coping about anxiety
and use of interventions, such as stress
management, relaxation and other
methods used to decrease anxiety.
3. Family support without pressure to
remember
4. Nutritional support

CONTINUOUS AMNESIA
the inability to recall events from a specific time
through the present.

SYSTEMATIZED AMNESIA
the client cannot remember events that relate to a
specific category of information such as the one’s
family, or to one particular person or event.

THERAPEUTIC NURSING MANAGEMENT

1) Psychological Treatment:
a. Individual Therapy may be used in
providing psychosocial support and
understanding of the illness process as
well as a therapeutic plan.